When inadequate training stress is applied and recovery time is insufficient, performance reduction and chronic maladaptation occurs. Known as overtraining syndrome (OTS), this complex condition afflicts horses in top training. The name of the syndrome implies causation and it is necessary to differentiate it from over-reaching, a term used in horses that, after suffering a loss of performance without an obvious clinical reason, recover their performance within 1 or 2 weeks. The term OTS should be used for horses in heavy training losing performance without an obvious clinical reason and which is sustained for > 2 weeks. Despite considerable scientific investigations, the underlying mechanisms are still poorly understood and there are no objective biomarkers for OTS. An imbalance between training and recovery seems to be the primary cause of this dysfunction. However, other factors such as transport, feeding, subclinical disease and general management may play a role. There is now sufficient evidence that red cell hypervolaemia is not a mechanism for the OTS in horses. A dysfunction of the hypothalamo-pituitary-adrenocortical axis is momentarily the only mechanism that may be related to the development of this syndrome. In the absence of a scoring system to assess the psychological status of horses, the most effective method for diagnosis is the thorough assessment of the history and presenting complaint (length of unexplained performance deficit, weight loss despite adequate feed intake, concurrence of unspecific subclinical problems, unsuccessful treatments and changes of behaviour). Standardised exercise tests are suggested to provide a way to detect subtle changes in hormonal responses in the individual, which may make an important contribution to the detection of early overtraining. But further longitudinal studies are needed to clarify mechanism(s) underlying OTS and to establish the potential for the use of a physiological test as a predictive tool of this disorder.